Provider Demographics
NPI:1043729627
Name:JAROSCHAK, JODI MORRIS (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:MORRIS
Last Name:JAROSCHAK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9507 SW OTTER LN
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-8964
Mailing Address - Country:US
Mailing Address - Phone:954-815-3107
Mailing Address - Fax:
Practice Address - Street 1:7301 SW GAINES AVE
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7332
Practice Address - Country:US
Practice Address - Phone:772-888-1556
Practice Address - Fax:772-888-1556
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-26
Last Update Date:2017-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA76404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist